Between the lines: The 50th anniversary of long-term central venous catheters.

Background: Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor.

Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese.

Background: This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG).

Methods: A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS.

Results: In this study, 230 patients (83% female) with a mean age of 49.

Quality of life after sleeve gastrectomy and adjustable gastric banding.

Background: With the addition of laparoscopic vertical sleeve gastrectomy (SG) to the bariatric surgery procedural toolkit, patients desiring a restrictive bariatric procedure often choose between adjustable gastric banding (LAGB) and SG. One study compared quality of life after these 2 procedures and found no difference. The purpose of our study was to re-evaluate the postoperative quality of life in LAGB and SG patients at a military teaching hospital in the United States.

Does concomitant anterior fundoplication promote dysphagia after laparoscopic Heller myotomy?

Concerns for gastroesophageal reflux after laparoscopic Heller myotomy for achalasia justify considerations of concomitant anterior fundoplication. This study was undertaken to determine if concomitant anterior fundoplication reduces symptoms of reflux after myotomy without promoting dysphagia. From 1992 to 2004, 182 patients underwent laparoscopic Heller myotomy without fundoplication.

Routine intraoperative cholangiography during laparoscopic cholecystectomy minimizes unnecessary endoscopic retrograde cholangiopancreatography in children.

Purpose: The aim of this study was to determine the necessity for intraoperative cholangiography (IOC) during pediatric laparoscopic cholecystectomy (LC).

Methods: A retrospective review of 100 consecutive patients undergoing LC was conducted.

Results: Ninety-eight children underwent successful LC.

Transplantation of adult living donor kidneys into infants and small children.

Hypothesis: We hypothesized that improved outcomes following renal transplantation in high-risk infants and small children primarily are due to advances in immunosuppression and accurate diagnosis of rejection. Optimizing renal allograft perfusion is critical to achieving good early graft function and decreasing early graft loss.

Design: Twenty-eight consecutive recipients (weighing <20 kg) of adult living donor kidneys transplanted at our center from 1984 to 1999 were reviewed.

Minimally invasive surgery and clinical decision-making for pediatric malignancy.

Background: Minimally invasive surgery (MIS) is an ideal way to obtain biopsy specimens in children with cancer. We examined the safety, reliability and outcome of decisions made based on tissue obtained using MIS.

Methods: Fifty-nine oncology patients underwent 62 MIS procedures between January 1994 and July 1998.

Asymptomatic inferior vena cava abnormalities in three children with end-stage renal disease: risk factors and screening guidelines for pretransplant diagnosis.

We report two children with end-stage renal disease (ESRD) found to have inferior vena cava (IVC) thrombosis at the time of renal transplantation. The children suffered from renal diseases that included congenital hepatic fibrosis and portal hypertension as part of their pathophysiology. Neither child had evidence of hypercoaguability or clinical symptoms of IVC thrombosis.

Delayed primary repair of esophageal atresia with tracheoesophageal fistula: is it worth the wait?

Objective: To characterize a successful approach to the management of infants with long-gap esophageal atresia (EA) with tracheoesophageal fistula (TEF), significant prematurity with respiratory distress syndrome (RDS), or both, so as to preserve the native esophagus.

Design: A review of the medical records and office charts of a cohort of patients with EA and TEF.

Setting: A tertiary care children's hospital affiliated with a major university.

Aortic arch anomalies associated with long gap esophageal atresia and tracheoesophageal fistula.

Purpose: The purpose of this study was to determine whether aortic arch anomalies are associated with long gap esophageal atresia and tracheoesophageal fistula (EA-TEF).

Methods: The authors performed a retrospective review of all infants who had EA-TEF from 1980 to 1996 at two pediatric surgery centers. Two hundred three infants who had EA-TEF were identified.

Posterior sagittal anorectoplasty: primary repair of a rectovaginal fistula in an adult: report of a case.

Purpose: A case of an adult patient with the anorectal malformation of a rectovestibular fistula successfully repaired by performing a posterior sagittal anorectoplasty is reported. This case should increase the awareness of both primary and secondary anorectal malformations in the adult patient.

Methods: Management and outcome of an adult patient who presented with a rectovaginal fistula and underwent primary operative correction of her anorectal malformation using posterior sagittal anorectoplasty is reviewed.

Is pediatric laparoscopic splenectomy safe and cost-effective?

Objective: To determine whether laparoscopic splenectomy (LS) is a safe, cost-effective alternative to open splenectomy (OS).

Design: Retrospective comparison and economic evaluation.

Setting: Tertiary care children's hospital.

Video-assisted thoracoscopic closure of postpneumonectomy bronchopleural fistulas.

Despite improved surgical techniques and advances in medical-surgical treatment, postpneumonectomy bronchopleural fistulas remain an important cause of morbidity and a therapeutic challenge. Video-assisted thoracoscopic closure of these fistulas reinforced by transposition of bulky chest wall muscles or omentum to obliterate the residual space may lessen risks and complications of repeated thoracotomy in these often frail, debilitated, and compromised patients. We report our initial experience with video-assisted thoracoscopic debridement of the empyema cavity and closure of the postpneumonectomy bronchopleural fistula by transposing an entire pectoralis major muscle in one patient and by transposing a pedicled omentum in another patient.

The surgical management of giant cervicofacial lymphatic malformations.

Giant cervicofacial lymphatic malformation, a potentially life-threatening congenital malformation, historically has been removed in staged resections. However, complete surgical extirpation is desirable and can be achieved with the aid of a multidisciplinary team. The authors present the case of a 12-year-old girl who had an extensively enlarged cervicofacial lymphatic malformation.

Identification and surgical management of cystic retroperitoneal lymphangioma in children.

Retroperitoneal lymphangiomas are rare, benign cystic structures that are best evaluated with computed tomography and ultrasound. Preoperative diagnosis is often difficult, in part because there is little to distinguish them from other cystic masses and because the lesion is often not considered on the differential diagnosis. Surgery may be required as both a diagnostic and therapeutic measure.

Does posterior sagittal anorectoplasty in patients with high imperforate anus provide superior fecal continence?

The posterior sagittal anorectoplasty (PSARP) has become the primary surgical procedure for patients with high imperforate anus. Very few careful long-term follow-up studies have established the superiority of the PSARP procedure over other surgical repair techniques. The authors' goal was to evaluate the operation and to identify the factors associated with improved continence.

Management of transected pancreas in children.

The pancreas is the fourth most commonly injured intra-abdominal organ in children who sustain blunt abdominal trauma. Appropriate management of the injured pancreas has been controversial. With the advent of the computerized tomography scan, paediatric surgeons have tended to manage pancreatic injuries non-operatively.

Lessons learned in the management of hemolytic uremic syndrome in children.

Escherichia coli O.157:H7 is a serious and common human pathogen that can cause diarrhea, hemorrhagic colitis, and the hemolytic uremic syndrome (HUS). During a massive outbreak of infection with E coli O157:H7 in January 1993 in Washington State, more than 600 people, mostly children, acquired symptomatic infection, and 37 were hospitalized with HUS at Children's Hospital and Medical Center in Seattle, and six at other hospitals in Washington.

Limited surgery for lower-segment Hirschsprung's disease.

Objective: To determine if rectal myectomy is an effective treatment for a specific group of patients with Hirschsprung's disease.

Design: Retrospective series with follow-up of 6 to 132 months (mean follow-up, 37.1 months).

Videothoracoscopic wedge resection for peripheral pulmonary nodules.

Background: This study was done to evaluate the use of the endoscopic multifire linear stapler for videothoracoscopic wedge resection (VTWR) of peripheral pulmonary nodules and to define the indications, advantages, and drawbacks of this minimally invasive technique.

Study Design: A case study review of 57 consecutive video-assisted thoracic operations for wedge resection of peripheral pulmonary nodules performed upon 55 patients admitted to a community hospital from June 1991 through July 1993 is presented.

Results: There were 44 malignant and 13 benign lesions.

Growth factor profiles in breast cyst fluid identify women with increased breast cancer risk.

Gross cystic disease and breast cancer are hormonally induced diseases that may share a common biochemical environment conducive to abnormal proliferative responses. Breast cyst fluid samples were analyzed for specific growth factors and levels were compared with breast cancer risk. Growth factor profiles identified both women at increased breast cancer risk and subgroups of women with distinct clinical manifestations of gross cystic disease.

Early recognition of neonatal abdominal wall necrotizing fasciitis.

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires early diagnosis followed by aggressive surgical débridement. During a 10-year period, we treated 7 infants who developed NF.

Modulation of the excitability of avian peripheral nerves by vitamin D: relation to calbindin-D28k, calcium status and lipid composition.

Calbindin-D28k (CaBP), previously localized in some of the cell bodies of ganglia of the avian intestinal (Remark's) nerve, was shown to be vitamin D-dependent. In the present studies, the effect of vitamin D3 on electrophysiological properties of this nerve was examined in vitro. Electrical stimulation of the nerve yielded a compound action potential with two primary components, Peaks I and II.

Detection of biological activity in the cerebrospinal fluid of patients with central nervous system tumors.

Tumor markers for brain tumors are important for initial diagnosis and monitoring of treatment. We used a modification of the phagokinetic track assay, which measures the migration of cells across a coverslip that is coated with colloidal gold, to assess whether the CSF from patients with brain tumors and other non-neoplastic neurological disorders altered the migration of Balb/c 3T3 fibroblasts. We found that CSF from patients with brain tumors stimulated the migration activity at a significantly higher level than did CSF from patients without tumors (mean migration activity: 65 +/- 9% for CSF from 113 patients with brain tumors; 14 +/- 4% for 44 patients with non-neoplastic CNS disease; and 9 +/- 1.